1. Lipid Lowering Drug Prescribing: ‘patchy’ guideline adherence despite multi-faceted interventions M.E. Cupples 1, Terry Bradley, Chris Hall 1 Dept General Practice, Queen’s University, Belfast (m.cupples@qub.ac.uk) Background Lipid lowering drugs are valuable in coronary heart disease (CHD) prevention but, whilst clear prescribing criteria exist, there is evidence of confusion in their use. Research suggests guideline adherence may be improved with local discussion, supplementary expert advice or audit feedback. Objective We aimed to examine, in everyday general practice, the level of adherence to guidelines for prescribing lipid lowering drugs following (1) distribution of guidelines, (2) group discussion with local expert and (3) audit feedback. Results In total 348 patients were identified, with similar numbers in each interval. No differences in the proportions of patients with a BP recorded in the previous 6 months (72%) or smoking status recorded (>80%) were found between intervals. The table shows the percentages within each interval with recorded evidence of other prescribing criteria having been considered. Interval Criterion 1 (post 2 (post 3 (post distribution) discussion) feedback) Diabetes 46% 65% 54% Cholesterol 80% 80% 65% Diet advice 31% 30% 55% Exercise advice 16% 17% 45% Of the patients identified in Interval 3, 57.5% (73/127) had no recorded evidence of CHD. Prescribing was on the advice of a hospital physician for approximately 30% of these. Of the 127, 27% were known to have diabetes, 23% were known not to have diabetes but for 50% no evidence of diabetic status having been considered was found. Conclusion Adherence to prescribing guidelines for lipid lowering drugs is patchy in a working group of general practices despite multi-faceted interventions. Clear communication between primary and secondary care physicians is essential in establishing evidence of good prescribing practice. The individuality of practitioners and patients and the ‘art’ of medicine must be recognised when seeking to implement guidelines. Acknowledgements: Funding: The Regional Multi-professional Audit Committee, N Ireland. Our thanks to all participants and especially to Colette Murdock, Maura Corry, Matt McMurray and Siobhan McCann for their contributions to data recording and analysis. Method All patients, who were newly prescribed lipid lowering drugs during 3 separate successive 3 month intervals, were identified retrospectively in a locality group of 11 Belfast general practices (population 70,000). A nurse trained in audit searched primary care records three months after distribution of guidelines (Interval 1), after discussion of these guidelines in a multi-professional group with a local expert (Interval 2) and after audit feedback (Interval 3). Recorded evidence of criteria reflecting physicians’ adherence to prescribing guidelines were sought. The agreed criteria included lifestyle advice (diet and exercise), cholesterol assay (within 3 months prior to prescription), blood pressure (in 6 months prior to prescription), presence/absence of diabetes mellitus and smoking habit. A recently trained GP working in the group performed a quality check on a 10% random sample of records. The group initially decided it was not necessary to record evidence of a diagnosis of CHD. This decision changed following audit feedback and it was agreed to include this in data collection for Interval 3. Of the 11 practices, 2 were excluded from study: 1 withdrew after initial agreement to participate, 1 had unreliable data available due to changing practice computer systems.